Angioplasty and stent placement - carotid artery
The blood vessels that bring blood to your brain and face are called the carotid arteries. You have a carotid artery on each side of your neck.
The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). A blockage in your carotid artery can reduce the blood supply to your brain. A stroke can occur if your brain does not get enough blood.
Two procedures can be used to treat a carotid artery that is narrowed or blocked. These are:
- Surgery to remove plaque buildup (endarterectomy
- Carotid angioplasty with stent placement
Carotid angioplasty and stenting (CAS) is done using a small surgical cut.
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- Your surgeon will make a surgical cut in your groin after using some numbing medicine. You will also be given medicine to relax you.
- The surgeon places a catheter (a flexible tube) through the cut into an artery. It is carefully moved up to your neck to the blockage in your carotid artery. Moving x-ray pictures (fluoroscopy) are used to see the artery and guide the catheter to the correct position.
- Next, the surgeon will move a wire through the catheter to the blockage. Another catheter with a very small balloon on the end will be pushed over this wire and into the blockage. Then the balloon is inflated.
- The balloon presses against the inside wall of your artery. This opens the artery and sends proper blood flow to your brain. A stent (a wire mesh tube) may also be placed in the blocked area. The stent is inserted at the same time as the balloon catheter. It expands with the balloon. The stent is left in place to help keep the artery open.
- The surgeon then removes the balloon.
Carotid angioplasty and stenting; CAS; Angioplasty - carotid artery
Why the Procedure Is Performed
Carotid surgery (endarterectomy
) is the first choice for treating narrowed or blocked arteries. This procedure is very safe.
Carotid angioplasty and stenting carries a higher risk of leading to a stroke. However, it can be used as an alternative in situations where carotid surgery is not a good option. These may include:
- The person is too ill to have carotid endarterectomy.
- The location of the narrowing in the carotid artery makes surgery harder.
- The person has had neck or carotid surgery in the past.
- The person has had radiation to the neck.
Risks of carotid angioplasty and stent placement are:
- Allergic reaction to dye
- Blood clots
or bleeding at the site of surgery
- Brain damage
- Clogging of the inside of the stent (in-stent restenosis)
- Heart attack
- Kidney failure (higher risk in people who already have kidney problems)
- More blockage of the carotid artery over time
(this is rare)
(more likely with carotid artery angioplasty than with carotid endarterectomy)
Before the Procedure
Your doctor will do a physical exam and perform several medical tests.
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
- Days before the surgery, you may have to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
- Ask your doctor which drugs you should still take on the day of your surgery.
- If you smoke, you need to stop. Ask your doctor or nurse for help quitting.
- Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
Do NOT drink anything after midnight the night before your surgery, including water.
On the day of your surgery:
- Take the drugs your doctor told you to take with a small sip of water.
- Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
After surgery, your doctor may want you to stay in the hospital overnight so that nurses can watch you for any signs of bleeding, stroke, or poor blood flow to your brain. You may be able to go home the same day if your procedure is done early in the day and you are doing well. Your nurse will talk to you about how to care for yourself
Carotid artery angioplasty may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program if your doctor tells you exercise is safe for you.
Brott TG, Halperin JL, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. J Am Coll Cardiol.2011;
International Carotid Stenting Study Investigators. Dobson EJ, Featherstone RL, Bonati LH, van der Worp HB, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010;375:985-997.
Murad MH, Shahrour A, Shan ND, et al. A systematic review and meta-analysis of randomized trials of carotid endarterectomy vs. stenting. J Vasc Surg. 2011 Mar;53(3):792-7.
Eisenhauer AC, White CJ, Bhatt DL. Endovascular treatment of noncoronary obstructive vascular disease. In: Bonow Ro, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 63.
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.